Vulvovaginitis is a common condition in adolescents—especially sexually active girls. The diagnosis is usually confirmed by the presence of vulvitis in addition to a vaginal discharge. The physical characteristics of the vaginal discharge can point towards the most likely etiology. Gram stain, wet preparations and culture and sensitivity tests are indicated to define an exact etiology of vaginitis in the adolescent girl as the treatment is dependent on the etiology. Treatment of bacterial vaginosis is mainly metronidazole. Candida vaginitis responds well to clotrimazole. Chlamydial and gonorrheal vaginitis should be treated with azithromycin plus ceftriaxone. Trichomonas vaginitis should be treated with metronidazole.

00:01
Let's now talk about non-specific causes of vulvovaginitis.
00:05
Sometimes you can see vulvovaginitis in young girlsspecifically because they are now starting to toilet on their ownand do their own hygiene regimen.
00:16
This can sometimes lead to poor hygiene.
00:18
So it's important to emphasize good hygiene in these patients.
00:23
Also, you should encourage young girls to wear white cotton underpantsas sometimes colored or dyed underwear can cause irritation.
00:32
Avoidance of bubble baths and shampooing in the bathor using harsh soaps is advised as this can irritate the vulva,which is sensitive.
00:42
Loose fitting underpants and pajamas are necessary.
00:46
If a young girl is in gymnastics, ballet or perhaps figure skating,those outfits and costumes can be very tight and cause chronic irritation.
00:55
And in addition girls can sit in plain waterand it helps protect the vulva and perineumand also encourages good hygiene.
01:05
This is sometimes referred to as a sitz bath.
01:08
I also want to bring your attention to labial agglutination.
01:12
This is happens in a hypoestrogenic stateand what happens is the labia actually stick together.
01:19
This can be very painful.
01:21
In the first picture here you'll see evidence of a labial agglutination.
01:27
However, after treatment you can see that the labia can be separated.
01:30
This is a cartoon representation of what labial agglutination looks like.
01:36
You can see here that maybe there is a clitoris and the labia are fused.
01:40
You can try to separate them gently with the q-tip.
01:44
If they don't separate naturally don't force it.
01:48
These patients require estrogen therapy and typically they'll get betterand their labia will actually fall apart on their own.
01:56
Okay, let's review everything that we've discussed.
02:02
Don't forget that little girls are vulnerable to sexual abuse.
02:06
The most common foreign body in a young girl causing vaginitisis toilet tissue.
02:11
Young girls lack estrogen making their vulva prone to irritation.
02:17
All abused in young girls needs to be reported to the local authorities.
02:22
Good hygiene and appropriate clothingcan prevent non-specific vulvovaginitis.
02:29
Thank you for listening and good luck on your exam.

About the Lecture

The lecture Non-Specific Vulvovaginitis and Labial Agglutination by Lynae Brayboy, MD is from the course Pediatric Gynecology. It contains the following chapters:

Management of Non-Specific Vulvovaginitis

Labial Agglunation

Included Quiz Questions

Which of the following is NOT an appropriate in the management of non specific vulvovaginitis?

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